Two-stage robotic gastrectomy after bypass surgery for a perforated non-curative endoscopic submucosal dissection scar: a case report.

Here, we report a case of scar perforation caused by endoscopic dilation while the patient was waiting for additional gastrectomy after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer. Although conservative treatment prevented the progression of generalized peritonitis, one-stage meticulous surgery was contraindicated because of abscess formation around the pylorus, which is the main target of lymphatic dissection. Therefore, we performed a two-stage surgery. Prior laparoscopic gastrojejunal bypass for peritonitis control and nutritional management allowed for uncompromised curative gastrectomy using a robotic approach. Among the various treatment strategies, our selected two-stage surgery was useful in achieving uncompromised cancer surgery in patients with perforated peritonitis after noncurative ESD, where prophylactic dissection was the primary objective.

Supplementary information: The online version contains supplementary material available at 10.1007/s13691-025-00766-x.